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23152 Paraneoplastic Autoantibody Evaluation, Serum (PAVAL)

Paraneoplastic Autoantibody Evaluation, Serum (PAVAL)
Test Code: PARASO
Synonyms/Keywords
​AGNA, Amphiphysin Antibody, Serum, ANNA (Antineuronal Nuclear Antibody), Anti-CV2, Anti-Enteric Neuronal Antibody, Anti-GAD65 (Anti-Glutamic Acid Decarboxylase), Anti-Glial Nuclear Antibody, Anti-Hu, Anti-Purkinje Cell Cytoplasmic Antibodies, Anti-Ri, Anti-Yo, Antineuronal, APCA (Anti-Purkinje Cell Antibodies), Calcium Channel Blockers, Cerebellar Antibodies, Chorea, Cramp-fasciculation, CRMP-5, IgG, Dorsal Root Ganglion Antibody, Glutamate Decarboxylase Antibodies (GAD65), Hu Antibody, Motor End-Plate Antibody, Motor Nerve Terminal Antibodies, Myoid Antibody, N-Type Calcium Channel Antibody, Neuromyotonia, Neuronal Nuclear Antibody, Neuronal Nuclear Antibody Panel, Neuronal Potassium Channel Ab, Neuronal-Anti, Ovarian Cancer-Related Antibodies, P/Q Type Calcium Channel Antibody, Paraneoplastic Antibodies, Paraneoplastic Autoantibody Evaluation, Paraneoplastic Neurological Autoimmunity, PCA-1 (Purkinje Cell Cytoplasmic Antibodies), PCA-2 (Purkinje Cell Cytoplasmic Antibodies), PCA-Tr (Purkinje Cell Cytoplasmic Antibodies), PCAb (Purkinje Cell Cytoplasmic Antibodies), Potassium Channel Antibodies (specify), Purkinje Cell Cytoplasmic Antibodies, Type 1, Purkinje Cell Cytoplasmic Antibodies, Type 2, Purkinje Cell Cytoplasmic Antibodies, Type Tr, Ri, Anti, Stiff-man Syndrome, VGCC (Voltage-Gated Calcium Channel) Antibodies, VGKC, VGPC, Voltage-Gated Potassium Channel Ab, Yo-Anti ,Neuronal Ganglionic Acetylcholine Receptor Antibody, Cantoxin Receptor Antibodies, Collapsin Response-Mediator Protein-5 Antibody (CRMP-5), Isaacs Disease, Neuromuscular Hyperexcitability, Purkinje Cell Cytoplasmic Antibodies, Alpha-3
Useful For
​Serological evaluation of patients who present with a subacute neurological disorder of undetermined etiology, especially those with known risk factors for cancer
 
Directing a focused search for cancer
 
Investigating neurological symptoms that appear in the course of, or after, cancer therapy, and are not explainable by metastasis
 
Differentiating autoimmune neuropathies from neurotoxic effects of chemotherapy
 
Monitoring the immune response of seropositive patients in the course of cancer therapy
 
Detecting early evidence of cancer recurrence in previously seropositive patients
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ Serum Separator Tube (SST)​ 4 mL​ 2 mL​
Collection Processing Instructions

​Include relevant clinical information, name, phone number, mailing address, and e-mail address (if applicable) of ordering physician.

Patient Preparation:

1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication.

2. This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.

3. Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Refrigerated (preferred)​ 28 days​
Ambient ​ 72 hours​
Frozen ​ ​28 days
Rejection Criteria
Gross hemolysis
​Gross lipemia
​Gross icterus
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories​
 
​Monday through Sunday
10 days
Indirect Immunofluroescence Assay (IFA), Radioimmunoasay (RIA), Western Blot (WB), Immunoblot (IB), Cell-Binding Assay (CBA), Flow Cytometry
Reference Lab
Test Information

Paraneoplastic autoimmune neurological disorders reflect a patient's humoral and cellular immune responses to cancer. The cancer may be new or recurrent, is usually limited in metastatic volume, and is often occult by standard imaging procedures. Autoantibodies specific for onconeural proteins found in the plasma membrane, cytoplasm, and nucleus of neurons, glia, or muscle are generated in this immune response and serve as serological markers of paraneoplastic autoimmunity. Cancers recognized in this context most commonly are small-cell lung carcinoma, thymoma, ovarian (or related mullerian) carcinoma, breast carcinoma, and Hodgkin lymphoma. Pertinent childhood neoplasms recognized thus far include neuroblastoma, thymoma, Hodgkin lymphoma, and chondroblastoma. An individual patient's autoantibody profile can predict a specific neoplasm with 90% certainty, but not the neurological syndrome.

Four classes of autoantibodies are recognized in this evaluation:

-Neuronal nuclear (ANNA-1, ANNA-2, ANNA-3)

-Anti-glial/neuronal nuclear (AGNA-1; also known as Sox1)

-Neuronal and muscle cytoplasmic (PCA-1, PCA-2, PCA-Tr, CRMP-5, amphiphysin, and striational)

-Plasma membrane cation channel, calcium channels, P/Q-type and N-type calcium channel, dendrotoxin-sensitive potassium channels, and neuronal (ganglionic) and muscle nicotinic acetylcholine receptors (AChR). These autoantibodies are potential effectors of neurological dysfunction.

Seropositive patients usually present with subacute neurological symptoms and signs such as encephalopathy; cerebellar ataxia; myelopathy; radiculopathy; plexopathy; or sensory, sensorimotor, or autoimmune neuropathy, with or without a neuromuscular transmission disorder: Lambert-Eaton syndrome, myasthenia gravis, or neuromuscular hyperexcitability. Initial signs may be subtle, but a subacute multifocal and progressive syndrome usually evolves. Sensorimotor neuropathy and cerebellar ataxia are common presentations, but the clinical picture in some patients is dominated by striking gastrointestinal dysmotility, limbic encephalopathy, basal ganglionitis, or cranial neuropathy (especially loss of vision, hearing, smell, or taste).

Cancer risk factors include past or family history of cancer, history of smoking, or social or environmental exposure to carcinogens. Early diagnosis and treatment of the neoplasm favor less neurological morbidity and offer the best hope for survival.

Reference Range Information
Interpretive report.
Interpretation
​Antibodies directed at onconeural proteins shared by neurons, glia, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. Several autoantibodies have a syndromic association, but no autoantibody predicts a specific neurological syndrome. Conversely, a positive autoantibody profile has 80% to 90% predictive value for a specific cancer. It is not uncommon for more than 1 paraneoplastic autoantibody to be detected, each predictive of the same cancer.
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
83519​ 3 Immunoassay analyte Quant radioimmunoassay
86255 ​9 Fluorescent nonnfct agt antb screen ea antibody
83519​ ​1 ARBI ​As needed
​86255​1​ACMFS​As needed
84182 ​ ​1 AGNBS ​As needed
​86255 ​1 AMPCS ​As needed
​86256 ​1 ​AMPIS ​As needed
​84182 ​1 ​AMIBS ​As needed
​84182 ​1 AN1BS ​As needed
​84182 ​1 AN2BS ​As needed
​86255 ​1 CS2CS As needed
​84182 ​1 ​CRMWS ​As needed
​86255 ​1 DPPCS ​As needed
​86256 ​1 DPPTS ​As needed
​86255 ​1 DPPIS ​As needed
​86255 ​1 ​GABCS ​As needed
​86256 ​1 GABIS ​As needed
​86341 ​1 GD65S ​As needed
​86255 ​1 LG1CS ​As needed
​86255 ​1 GL1CS ​As needed
​86256 ​1 GL1TS ​As needed
​86255 ​1 ​GL1IS ​As needed
​86255 ​1 ​NMDCS ​As needed
​86256 ​1 ​NMDIS ​As needed
​84182 ​1 ​PC1BS ​As needed
​84182 ​1 PCTBS ​As needed
Synonyms/Keywords
​AGNA, Amphiphysin Antibody, Serum, ANNA (Antineuronal Nuclear Antibody), Anti-CV2, Anti-Enteric Neuronal Antibody, Anti-GAD65 (Anti-Glutamic Acid Decarboxylase), Anti-Glial Nuclear Antibody, Anti-Hu, Anti-Purkinje Cell Cytoplasmic Antibodies, Anti-Ri, Anti-Yo, Antineuronal, APCA (Anti-Purkinje Cell Antibodies), Calcium Channel Blockers, Cerebellar Antibodies, Chorea, Cramp-fasciculation, CRMP-5, IgG, Dorsal Root Ganglion Antibody, Glutamate Decarboxylase Antibodies (GAD65), Hu Antibody, Motor End-Plate Antibody, Motor Nerve Terminal Antibodies, Myoid Antibody, N-Type Calcium Channel Antibody, Neuromyotonia, Neuronal Nuclear Antibody, Neuronal Nuclear Antibody Panel, Neuronal Potassium Channel Ab, Neuronal-Anti, Ovarian Cancer-Related Antibodies, P/Q Type Calcium Channel Antibody, Paraneoplastic Antibodies, Paraneoplastic Autoantibody Evaluation, Paraneoplastic Neurological Autoimmunity, PCA-1 (Purkinje Cell Cytoplasmic Antibodies), PCA-2 (Purkinje Cell Cytoplasmic Antibodies), PCA-Tr (Purkinje Cell Cytoplasmic Antibodies), PCAb (Purkinje Cell Cytoplasmic Antibodies), Potassium Channel Antibodies (specify), Purkinje Cell Cytoplasmic Antibodies, Type 1, Purkinje Cell Cytoplasmic Antibodies, Type 2, Purkinje Cell Cytoplasmic Antibodies, Type Tr, Ri, Anti, Stiff-man Syndrome, VGCC (Voltage-Gated Calcium Channel) Antibodies, VGKC, VGPC, Voltage-Gated Potassium Channel Ab, Yo-Anti ,Neuronal Ganglionic Acetylcholine Receptor Antibody, Cantoxin Receptor Antibodies, Collapsin Response-Mediator Protein-5 Antibody (CRMP-5), Isaacs Disease, Neuromuscular Hyperexcitability, Purkinje Cell Cytoplasmic Antibodies, Alpha-3
Ordering Applications
Ordering Application Description
​Centricity ​Paraneoplastic AutoAntibody Eval
​Cerner ​Paraneoplastic AutoAb Eval (83380)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ Serum Separator Tube (SST)​ 4 mL​ 2 mL​
Collection Processing

​Include relevant clinical information, name, phone number, mailing address, and e-mail address (if applicable) of ordering physician.

Patient Preparation:

1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication.

2. This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.

3. Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Refrigerated (preferred)​ 28 days​
Ambient ​ 72 hours​
Frozen ​ ​28 days
Rejection Criteria
Gross hemolysis
​Gross lipemia
​Gross icterus
Useful For
​Serological evaluation of patients who present with a subacute neurological disorder of undetermined etiology, especially those with known risk factors for cancer
 
Directing a focused search for cancer
 
Investigating neurological symptoms that appear in the course of, or after, cancer therapy, and are not explainable by metastasis
 
Differentiating autoimmune neuropathies from neurotoxic effects of chemotherapy
 
Monitoring the immune response of seropositive patients in the course of cancer therapy
 
Detecting early evidence of cancer recurrence in previously seropositive patients
Reference Range Information
Interpretive report.
Interpretation
​Antibodies directed at onconeural proteins shared by neurons, glia, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. Several autoantibodies have a syndromic association, but no autoantibody predicts a specific neurological syndrome. Conversely, a positive autoantibody profile has 80% to 90% predictive value for a specific cancer. It is not uncommon for more than 1 paraneoplastic autoantibody to be detected, each predictive of the same cancer.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories​
 
​Monday through Sunday
10 days
Indirect Immunofluroescence Assay (IFA), Radioimmunoasay (RIA), Western Blot (WB), Immunoblot (IB), Cell-Binding Assay (CBA), Flow Cytometry
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
83519​ 3 Immunoassay analyte Quant radioimmunoassay
86255 ​9 Fluorescent nonnfct agt antb screen ea antibody
83519​ ​1 ARBI ​As needed
​86255​1​ACMFS​As needed
84182 ​ ​1 AGNBS ​As needed
​86255 ​1 AMPCS ​As needed
​86256 ​1 ​AMPIS ​As needed
​84182 ​1 ​AMIBS ​As needed
​84182 ​1 AN1BS ​As needed
​84182 ​1 AN2BS ​As needed
​86255 ​1 CS2CS As needed
​84182 ​1 ​CRMWS ​As needed
​86255 ​1 DPPCS ​As needed
​86256 ​1 DPPTS ​As needed
​86255 ​1 DPPIS ​As needed
​86255 ​1 ​GABCS ​As needed
​86256 ​1 GABIS ​As needed
​86341 ​1 GD65S ​As needed
​86255 ​1 LG1CS ​As needed
​86255 ​1 GL1CS ​As needed
​86256 ​1 GL1TS ​As needed
​86255 ​1 ​GL1IS ​As needed
​86255 ​1 ​NMDCS ​As needed
​86256 ​1 ​NMDIS ​As needed
​84182 ​1 ​PC1BS ​As needed
​84182 ​1 PCTBS ​As needed
For most current information refer to the Marshfield Laboratory online reference manual.